Evaluation of the Effect of Isoniazid Preventive Therapy among Children Living with HIV in OLA During Children’s Hospital-Freetown, Sierra Leone

Abstract

The second biggest killer disease triggered by a single infectious agent and the leading cause of mortality for children living with HIV (CLHIV) is Tuberculosis (TB), rendering it an significant public health concern that needs aggressive preventive steps. In some nations, Isoniazid Preventive Therapy (IPT) has been introduced to shield children from the development of latent TB infection to active disease and also to avoid TB reinfection after exposure to an open case of childhood TB. The impact of IPT among CLHIV who completed IPT at the Ola Children's Hospital in Sierra Leone was evaluated. The study objective was to evaluate the effect of IPT among CLHIV at ODCH who completed IPT before February 2018 and still on HIV care and treatment. A cross sectional study with both qualitative and quantitative data collection was employed. Target population was 323 CLHIV enrolled and completed IPT before February 2018, 4 pediatric specialists and all Health care workers who provided treatment and care to these children in the previous one year. We used a cross sectional and mixed methods design. We collected quantitative data using self-administered semi structured questionnaires and qualitative data through Key informant interviews with the pediatric specialists. Data analysis was conducted using descriptive statistics and Multivariable logistic regression analysis to determine factors associated with TB incidence, mortality and quality of life among CLHIV. Majority of the children [200, 61.9%] weighed between 11-20 kg and were in WHO stage II [176, 54.5%]. With most children on 3TC [184, 57.7%] compared to 80[25.1%] on first line ART regime. Most respondents thought that TB was curable [281, 87%] [x2=176.84, p<0.05] and that TB was not a curse [271, 83.9%] [x2=148.48, p<0.05]. CLHIV aged less than 12 weeks compared to older children are more likely to be infected with TB (OR=2.777, p<0.05). Minority [205, 63.5%, x2=23.43, p<0.05] of the children were diagnosed with TB since February 2018. To moderate extent pain and discomfort was worrying [3.28, .862] and moderately handled any pain or discomfort among the child/children [3.23, .815] [x2=267.07, p<0.05].The study demonstrated efficiency of IPT in reduction of TB incidence in CLHIV. TB is can effectively be prevented through IPT prophylaxis alongside the ART regiment. This would significantly prevent pain and discomfort in HIV positive children. The study recommends that all CLHIV should be initiated on IPT to prevent them TB which is an opportunistic infection in HI/AIDS. Adequate funds allocation in the acquisition of adequate IPT treatment alongside proper coordination in the administration of the treatment by health workers. There is need for effective management of symptoms so as to improve quality of life among CLHIV